Doctors win lawsuit against Blue Cross Blue Shield

It’ll get tied up in appeals and everyone will lose except for trial attorneys.

James Williams from the Board of Supervisors tried it.

CDC doing CDC things

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Yeah that will be reduced to nothing

BCBS had approved several providers but she wanted the bougie place

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Paying less for out of network centers and doctors isn’t reducing the patients benefits. Lower % paid along with higher deductibles and higher out of pocket maximums for out of network centers and doctors are what you usually sign up for. Some plans may not pay anything for out of network. The center gets 80% if its patients from out of state which adds another variable into this.

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More than 80% of their patients come from outside the state.

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Also they had 2 cases dismissed at federal level before going state route. It could have been for purely procedural reasons, but I don’t know anymore than following quote -

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The state civil court jury deliberated for less than two hours Friday before rendering its unanimous verdict in the suit, the third attempt by the surgery center to seek payments after two earlier cases were dismissed in federal court.

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Another view besides the plaintiff’s attorney

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“If insurance companies were on the hook to pay whatever any provider charged, no provider would ever belong to a network and rates would be sky high.”

“If every provider says, I’m not going to join a network, I want my charges paid in full, you won’t have health insurance in the state of Louisiana anymore,”

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I've done my research, and I was like, ‘I feel very confident that this is where I want to go,’” Arch told BCBS.

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Hmmm. I was told doing your own research was the pastime of conspiracy theorists

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I guess all of our premiums are probably going up even more now.

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Yep, that’s how insurance works.

When men get cancer they just cut your balls off and put you on the street

Amazing how a complex legal contract issue goes to 12 New Orleans jurors to decide hundreds of millions... I’m sure the jury understood everything real well.

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However, I do hope this niche medical group is adequately compensated for their much appreciated expertise. The service they provide these women is pretty incredible.

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Doesn’t mean they don’t inflate prices billed to insurance companies or that patients don’t know that their insurance coverage for out of network would be much less and have to make up the difference. For a procedure or doctor visit I can go anywhere I want to go, but I know up front if I choose out of network I am responsible for anything not paid by insurance and know limits on out of network coverage versus in network. Besides a lower % of what’s considered a more typical rate the deductible is much higher and there is a higher out of pocket maximum (I have seen much worse out of network coverages than we currently have). The patients choose to make up the difference when they go out of network.

80% of patients coming from out of state with the center trying to negotiate with each state’s respective Blue Cross seems problematic from the start on getting patient and insurance on same page especially out of network which can differ from employer to employer and also state to state.

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Williams also argued that the local Blue Cross engaged in “repricing” reimbursement rates the hospital had negotiated with Blue Cross companies from other states that insured the hospital’s out-of-state patients.

In court documents, Blue Cross argued that authorizing a treatment does not guarantee payment. Insurers do not have a set reimbursement rate that they pay out-of-network providers. Rather, they negotiate individual deals with brokers or employers.

The company also denied that it engaged in repricing, though it has agreements with out-of-state Blue Cross plans that it helps administer and that determine how much it will pay on a claim.

The company said that does not amount to fraud, and also noted in court documents that it successfully defended two similar suits brought by the hospital against it in federal court in the early 2010s.

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https://www.nola.com/news/business/blue-cross-of-louisiana-shortchanged-new-orleans-surgical-center-by-421-million-jury-finds/article_6d58533e-79fc-11ef-82a9-af9fbab232b4.html

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Amazing how a complex legal contract issue goes to 12 New Orleans jurors to decide hundreds of millions... I’m sure the jury understood everything real well.

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This reminded me of my wife getting put on the jury of a large dollar amount business dispute where both sides only spoke manderin which all had to be translated to jury and judge and so on. One side was Chinese based in states and the other was based in China. My wife always came home with a glazed look and ready to take a nap. They ended up settling after a week.